The applicability of commonly used predictive scoring systems in Indigenous Australians with sepsis: An observational study

Background: Appendectomy is the most common abdominal surgery performed today. Appendicitis consists of vast spectrum ranging from acute to chronic to recurrent forms however existence of recurrent and chronic appendicitis is still doubted by many. In spite of various scoring systems and appendectomy being the ultimate treatment, its timing remains still controversial especially in chronic and recurrent variants of appendicitis.Methods: A total of 100 consecutive cases of suspected appendicitis who were admitted investigated and treated at our centre were taken up for this observational study. Data pertaining to clinical, operative and histopathological findings were collected and tabulated. Mean and SD were used for continuous data and for categorical data, frequency and percentages were calculated. A chi-square test was used for categorical data to find statistical significance.Results: Per operatively the appendix appeared non-inflamed in 57% of patients suggestive of chronic (recurrent) form and inflamed in 43% of patients suggestive of an acute form of appendicitis. The histopathological studies revealed chronic inflammatory cells in 63% of the resected specimens, suggestive of chronic appendicitis and acute inflammatory cells in 37% of the specimens, suggestive of acute appendicitis.Conclusions: We conclude that the correlation of clinical findings, operative findings and the histopathological findings correlate with one another (p<0.001). The surgeon’s clinical and operative findings have specificity of around 87.30% and 90.47% respectively. Hence the diagnostic accuracy of the surgeon is directly dependent on the surgeons’ expertise and there is no substitution for an experienced surgeon’s judgement.

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Hypocoagulable Tendency on Thromboelastometry Associated With Severity and Anticoagulation Timing in Pediatric Septic Shock: A Prospective Observational Study

Frontiers in Pediatrics ◽

10.3389/fped.2021.676565 ◽

2021 ◽

Vol 9 ◽

Author(s):

Ta Anh Tuan ◽

Nguyen Thi Thu Ha ◽

Tran Dang Xoay ◽

Tran Thi Kieu My ◽

Luong Thi Nghiem ◽

...

Keyword(s):

Septic Shock ◽

Observational Study ◽

Prospective Observational Study ◽

Area Under The Curve ◽

Scoring Systems ◽

International Normalized Ratio ◽

Secondary Outcome ◽

Optimal Timing ◽

Survival Group ◽

D Dimer

Objective: To identify whether coagulation profiles using thromboelastometry are associated with outcomes in pediatric septic shock. The primary outcomes were the development of disseminated intravascular coagulation (DIC) and the severity of the pediatric intensive care unit (PICU) existing scoring systems, while the secondary outcome was hospital mortality. This study aimed to contribute to current findings of the limitations of conventional tests in determining the optimal timing of anticoagulation in sepsis.Design: A prospective, observational study conducted between August 2019 and August 2020.Setting: PICU at a pediatric tertiary hospital in Hanoi, Vietnam.Patients: Fifty-five pediatric patients who met the septic shock criteria were enrolled.Measurements and Main Results: Fifty-five patients with septic shock were recruited. At the time of diagnosis, thromboelastometry revealed normocoagulability, hypercoagulability, and hypocoagulability in 29, 29, and 42% of the patients, respectively (p > 0.05); however, most patients in the overt DIC and non-survival groups progressed to hypocoagulability (82 and 64%, respectively). The overt DIC, PELOD-2 > 8, PRISM-III > 11, and non-survival group had a significant hypocoagulable tendency according to thromboelastometry parameters [prolonged clotting time (CT) and clot formation time (CFT); and reduced α-angle (α), maximum clot firmness (MCF), thrombodynamic potential index (TPI)] compared to the non-overt DIC, PELOD-2 ≤ 8, PRISM-III score ≤ 11 and survival group (p < 0.05). Conventional parameters between the normocoagulable and hypercoagulable groups were not different (p > 0.05). Hypocoagulability was characterized by lower platelet count and fibrinogen level, higher prolonged prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (APTT), and higher D-dimer level than in hypercoagulability (p < 0.05). Hypocoagulable tendency on thromboelastometry had a higher hazard at a PT > 16.1 s [area under the curve (AUC) = 0.747, odds ratio (OR) = 10.5, p = 0.002], INR > 1.4 (AUC = 0.754, OR = 6.9, p = 0.001), fibrinogen <3.3 g/L (AUC = 0.728, OR = 9.9, p = 0.004), and D-dimer > 3,863 ng/mL (AUC = 0.728, OR = 6.7, p = 0.004).Conclusions: Hypocoagulable tendency using thromboelastometry is associated with the severity of septic shock. Conventional coagulation tests may fail to detect hypercoagulability, which is crucial in determining anticoagulation timing.

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Development and external validation of new nomograms by adding ECG changes (ST depression or tall T wave) and age to conventional scoring systems to improve the predictive capacity in patients with subarachnoid haemorrhage: a retrospective, observational study in Korea

BMJ Open ◽

10.1136/bmjopen-2018-024007 ◽

2019 ◽

Vol 9 (2) ◽

pp. e024007 ◽

Cited By ~ 2

Author(s):

Ju young Hong ◽

Je Sung You ◽

Min Joung Kim ◽

Hye Sun Lee ◽

Yoo Seok Park ◽

...

Keyword(s):

Observational Study ◽

Subarachnoid Haemorrhage ◽

Characteristic Curve ◽

External Validation ◽

Scoring Systems ◽

Retrospective Observational Study ◽

World Federation ◽

Ecg Changes ◽

T Wave ◽

St Depression

ObjectivesTo develop new nomograms by adding ECG changes (ST depression or tall T wave) and age to three conventional scoring systems, namely, World Federation of Neurosurgical Societies (WFNS) scale, Hunt and Hess (HH) system and Fisher scale, that can predict prognosis in patients with subarachnoid haemorrhage (SAH) using our preliminary research results and to perform external validation of the three new nomograms.DesignRetrospective, observational studySettingEmergency departments (ED) of two university-affiliated tertiary hospital between January 2009 and March 2015.ParticipantsAdult patients with SAH were enrolled. Exclusion criteria were age <19 years, no baseline ECG, cardiac arrest on arrival, traumatic SAH, referral from other hospital and referral to other hospitals from the ED.Primary outcome measuresThe 6 month prognosis was assessed using the Glasgow Outcome Scale (GOS). We defined a poor outcome as a GOS score of 1, 2 or 3.ResultsA total of 202 patients were included for analysis. From the preliminary study, age, ECG changes (ST depression or tall T wave), and three conventional scoring systems were selected to predict prognosis in patients with SAH using multi-variable logistic regression. We developed simplified nomograms using these variables. Discrimination of the developed nomograms including WFNS scale, HH system and Fisher scale was superior to those of WFNS scale, HH system and Fisher scale (0.912 vs 0.813; p<0.001, 0.913 vs 0.826; p<0.001, and 0.885 vs 0.746; p<0.001, respectively). The calibration plots showed excellent agreement. In the external validation, the discrimination of the newly developed nomograms incorporating the three scoring systems was also good, with an area under the receiver-operating characteristic curve value of 0.809, 0.812 and 0.772, respectively.ConclusionsWe developed and externally validated new nomograms using only three independent variables. Our new nomograms were superior to the WFNS scale, HH systems, and Fisher scale in predicting prognosis and are readily available.

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High Prevalence of Oral HPV Infection Among Indigenous Australians: An Observational Study

SSRN Electronic Journal ◽

10.2139/ssrn.3471347 ◽

2019 ◽

Author(s):

Lisa M. Jamieson ◽

Annika Antonsson ◽

Gail Garvey ◽

Xiangqun Ju ◽

Megan Smith ◽

...

Keyword(s):

Observational Study ◽

Hpv Infection ◽

Indigenous Australians ◽

High Prevalence ◽

Oral Hpv

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Derivation and validation of the ED-SAS score for very early prediction of mortality and morbidity with acute pancreatitis: a retrospective observational study

BMC Emergency Medicine ◽

10.1186/s12873-021-00410-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Joseph Miller ◽

Yiyang Wu ◽

Rawan Safa ◽

Georgiana Marusca ◽

Sandeep Bhatti ◽

...

Keyword(s):

Acute Pancreatitis ◽

Observational Study ◽

Primary Outcome ◽

Validation Cohort ◽

Scoring Systems ◽

Retrospective Observational Study ◽

Mortality And Morbidity ◽

Derivation Cohort ◽

C Statistic ◽

Prediction Of Mortality

Abstract Background Existing scoring systems to predict mortality in acute pancreatitis may not be directly applicable to the emergency department (ED). The objective of this study was to derive and validate the ED-SAS, a simple scoring score using variables readily available in the ED to predict mortality in patients with acute pancreatitis. Methods This retrospective observational study was performed based on patient data collected from electronic health records across 2 independent health systems; 1 was used for the derivation cohort and the other for the validation cohort. Adult patients who were eligible presented to the ED, required hospital admission, and had a confirmed diagnosis of acute pancreatitis. Patients with chronic or recurrent episodes of pancreatitis were excluded. The primary outcome was 30-day mortality. Analyses tested and derived candidate variables to establish a prediction score, which was subsequently applied to the validation cohort to assess odds ratios for the primary and secondary outcomes. Results The derivation cohort included 599 patients, and the validation cohort 2011 patients. Thirty-day mortality was 4.2 and 3.9%, respectively. From the derivation cohort, 3 variables were established for use in the predictive scoring score: ≥2 systemic inflammatory response syndrome (SIRS) criteria, age > 60 years, and SpO2 < 96%. Summing the presence or absence of each variable yielded an ED-SAS score ranging from 0 to 3. In the validation cohort, the odds of 30-day mortality increased with each subsequent ED-SAS point: 4.4 (95% CI 1.8–10.8) for 1 point, 12.0 (95% CI 4.9–29.4) for 2 points, and 41.7 (95% CI 15.8–110.1) for 3 points (c-statistic = 0.77). Conclusion An ED-SAS score that incorporates SpO2, age, and SIRS measurements, all of which are available in the ED, provides a rapid method for predicting 30-day mortality in acute pancreatitis.

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Derivation and Validation of the ED-SAS Score for Very Early Prediction of Mortality and Morbidity with Acute Pancreatitis: A Retrospective Observational Study

10.21203/rs.3.rs-76144/v1 ◽

2020 ◽

Author(s):

Joseph Miller ◽

Yiyang Wu ◽

Rawan Safa ◽

Georgiana Marusca ◽

Sandeep Bhatti ◽

...

Keyword(s):

Acute Pancreatitis ◽

Observational Study ◽

Validation Cohort ◽

Scoring Systems ◽

Retrospective Observational Study ◽

Mortality And Morbidity ◽

Derivation Cohort ◽

C Statistic ◽

Prediction Of Mortality ◽

Level Data

Abstract Background: Existing scoring systems to predict mortality in acute pancreatitis may not be directly applicable to the emergency department (ED). The objective of this study was to derive and validate the ED-SAS, a simple scoring score using variables readily available in the ED to predict mortality in patients with acute pancreatitis. Methods: This retrospective observational study was performed based on patient level data collected from electronic health records across 2 independent health systems, one used for the derivation cohort and one for the validation cohort. Adult patients who were eligible presented to the ED, required hospital admission, and had a confirmed diagnosis of acute pancreatitis. Patients with chronic or recurrent episodes of pancreatitis were excluded. The primary outcome was 30-day mortality. Analyses tested and derived candidate variables to establish a prediction score and that was subsequently applied to the validation cohort to assess odds ratio for the primary and secondary outcomes. Results: The derivation cohort included 599 patients, and the validation cohort 2011 patients. Thirty-day mortality was 4.2% and 3.9% respectively. From the derivation cohort, 3 variables were established for use in the predictive scoring score: ≥2 systemic inflammatory response syndrome (SIRS) criteria, age >60 years, and SpO2 <96%. Summing the presence or absence of each variable yielded an ED-SAS score ranging from 0 to 3. In the validation cohort, the odds of 30-day mortality increased with each subsequent ED-SAS point: 4.4 (95% CI 1.8 – 10.8) for 1 point, 12.0 (95% CI 4.9 – 29.4) for 2 points, and 41.7 (95% CI 15.8 – 110.1) for 3 points (c-statistic = 0.77).Conclusion: An ED-SAS score that incorporates SpO2, age, and SIRS measurements provides a rapid method for predicting 30-day mortality in acute pancreatitis.

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EVALUATION OF APACHE- IV & SAPS- II SCORING SYSTEMS AND CALCULATION OF STANDARDISED MORTALITY RATE IN SEVERE SEPSIS AND SEPTIC SHOCK PATIENTS- A PROSPECTIVE OBSERVATIONAL STUDY

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2019/188 ◽

2019 ◽

Vol 8 (12) ◽

pp. 843-848

Author(s):

Siddhartha Chakraborty ◽

Sarbari Swaika ◽

Rajat Choudhuri ◽

Suchismita Mallick

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Mortality Rate ◽

Observational Study ◽

Prospective Observational Study ◽

Scoring Systems ◽

Saps Ii ◽

Sepsis And Septic Shock ◽

Apache Iv

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Derivation and Validation of the ED-SAS Score for Very Early Prediction of Mortality and Morbidity with Acute Pancreatitis: A Retrospective Observational Study

10.21203/rs.3.rs-75848/v1 ◽

2020 ◽

Author(s):

Joseph Miller ◽

MD ◽

Rawan Safa ◽

Georgiana Marusca ◽

BS Sandeep Bhatti ◽

...

Keyword(s):

Acute Pancreatitis ◽

Observational Study ◽

Validation Cohort ◽

Scoring Systems ◽

Retrospective Observational Study ◽

Mortality And Morbidity ◽

Derivation Cohort ◽

C Statistic ◽

Prediction Of Mortality ◽

Level Data

Abstract Background: Existing scoring systems to predict mortality in acute pancreatitis may not be directly applicable to the emergency department (ED). The objective of this study was to derive and validate the ED-SAS, a simple scoring score using variables readily available in the ED to predict mortality in patients with acute pancreatitis.Methods: This retrospective observational study was performed based on patient level data collected from electronic health records across 2 independent health systems, one used for the derivation cohort and one for the validation cohort. Adult patients who were eligible presented to the ED, required hospital admission, and had a confirmed diagnosis of acute pancreatitis. Patients with chronic or recurrent episodes of pancreatitis were excluded. The primary outcome was 30-day mortality. Analyses tested and derived candidate variables to establish a prediction score and that was subsequently applied to the validation cohort to assess odds ratio for the primary and secondary outcomes. Results: The derivation cohort included 599 patients, and the validation cohort 2011 patients. Thirty-day mortality was 4.2% and 3.9% respectively. From the derivation cohort, 3 variables were established for use in the predictive scoring score: ≥2 systemic inflammatory response syndrome (SIRS) criteria, age >60 years, and SpO2 <96%. Summing the presence or absence of each variable yielded an ED-SAS score ranging from 0 to 3. In the validation cohort, the odds of 30-day mortality increased with each subsequent ED-SAS point: 4.4 (95% CI 1.8 – 10.8) for 1 point, 12.0 (95% CI 4.9 – 29.4) for 2 points, and 41.7 (95% CI 15.8 – 110.1) for 3 points (c-statistic = 0.77).Conclusion: An ED-SAS score that incorporates SpO2, age, and SIRS measurements provides a rapid method for predicting 30-day mortality in acute pancreatitis.

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